The lack of adequate reception conditions to meet basic humanitarian standards also took their toll. MSF treated people for hypothermia and exhaustion after they were forced to sleep outside or wait in long queues without access to shelter, toilets, food, water or sanitation for days at a time. We were often unable to move people out of these queues for medical reasons. Others were forced to languish in dire reception centres – in Italy conditions became so inhumane that MSF decided it had no choice but to leave.

MSF also treated the psychological scars of the situations people had initially fled, the impact of the dire conditions on the journey and the uncertainty that people faced (a situation compounded by the lack of basic information available on the route). In late November, in Idomeni, for example, MSF psychologists noted a significant increase in the number of panic attacks and self-harm attempts, a direct consequence of the dire conditions faced by people at the border with FYROM and ongoing uncertainty about their futures.

Arbitrary decisions by governments along the route also increased the suffering and danger faced by people. Each time a border closed without consultation with the neighbouring country thousands were abruptly halted, stranded in no man’s land with little or no humanitarian assistance.

The policies of deterrence, border control and security have failed to deter people, working only to increase their suffering by making the journey to Europe more miserable, more dangerous and more expensive.

The report then moves onto identifying policy responses that would minimise suffering and save lives, centred largely on providing protection to people who need it. This includes safe and legal alternatives to dangerous journeys in the hands of smugglers, decent reception, proactive search and rescue. It also includes safe passage between EU countries and an end to acts of violence and abuse from state authorities.

“Through Greece, Italy, the Balkans and in northern France, MSF teams have witnessed first-hand the fundamental inhumanity of the political response to the European refugee crisis. By putting concerns of borders, security and deterrence ahead of the needs of those caught up in this crisis, politicians have failed in their responsibility to protect people, instead actively increasing suffering and costing lives. Whilst MSF can treat wounds and try to heal psychological scars, unless European governments abandon their obstacle course approach in 2016 the extreme suffering and death will continue.”